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Hayley Hutton Paediatric registrar
The use of Gabapentin for the management of pain in Guillain-Barré Syndrome in the paediatric setting.
29 October 2014
Guillain-Barr Syndrome in the paediatric setting. Gabapentin The - - PowerPoint PPT Presentation
Guillain-Barr Syndrome in the paediatric setting. Gabapentin The - - PowerPoint PPT Presentation
Hayley Hutton Paediatric registrar The use of Gabapentin for the management of pain in 29 October 2014 Guillain-Barr Syndrome in the paediatric setting. Gabapentin The Good The Bad And the Unknown... The unknown... Does OUR off label use
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The unknown...
Does OUR off label use of Gabapentin in Neuropathic pain stem from illicit marketing
- r is there some scientific evidence?
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Efficacy of Gabapentin?
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Minimal paediatric data
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None out of Africa
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Pandey et al: Efficacy and safety of Gabapentin in adults with severe Guillain-Barré Syndrome
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Some proven efficacy in conditions such as: complex regional pain syndromes; peri operatively; post herpetic neuralgia.
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Methodology
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Observational, retrospective study
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All patients admitted to RXH with Guillain- Barré syndrome 2002 - 2012
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Medical records and Prescription charts reviewed
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Data was collected using Epidata and analysed using STATA v12.0
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Incidence at RXH
4 8 12 16 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 No. Year
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Age of population
5 10 15 20 25 1 2 3 4 5 6 7 8 9 10 11 12 Age in years No.
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Characteristics of Hospital stay
Characteristic Overall Gaba Carba Neither P-value Length of hospital stay 14 days (+-43) 48 45 10 0.85
- No. Needing PICU
41% 64 59 17 Length of PICU stay 21 days (+-33) 26 31 15 0.18
- No. Needing ventilatory support 31%
50 52 8
- No. Needing a tracheostomy
28% 45 52 1 Duration on tracheostomy 54 days 57 58 31 0.68
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Characteristics of Pain
Characteristic Overall Gaba Carba Neither P-value Proportion with documented pain 76% 100 86 54 0.67 Mean no. Analgesics used 2.3 (+- 1.8) 3.4 3.2 1.2 0.67 Duration of pain 4 days (+-8) 12.7 13.4 4.2 0.90 Episodes of breakthrough pain 55% 77 79 4 Caregiver at bedside 93% 86 93 95
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Limitations of the study
❖ Retrospective nature ❖ Lack of standardized methods to measure pain
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Conclusions of the study
❖ Assessment of pain is suboptimal ❖ Dramatic increase in the use of Gabapentin at RXH
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Looking ahead...
❖ Randomized, double blinded control trial ❖ Gabapentin vs Carbamazepine for the management of
neuropathic pain
❖ Guillain-Barré Syndrome
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A very big thank you to Prof Jo Wilmshurst and Prof JennyThomas
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References:
❖ Walco GA, Dworkin RH, Krane EJ, LeBel AA, Treede RD. Neuropathic pain in children: special considerations.
Mayo Clinic Proceedings [Internet]. 2010 [cited 2012 Sep 17]. page S33–S41. Available from: http://171.67.112.83/content/85/3_suppl/S33.short
❖ Korinthenberg R, Mönting JS. Natural history and treatment effects in Guillain-Barré syndrome: a multicentre
- study. Arch Dis Child. 1996 Apr 1;74(4):281–7
❖ Kar S, Menon L, Mondal M, Mukherjee S, Pal R, Sarbapalli D, et al. Spectrum of Guillain-Barre syndrome in tertiary
care hospital at Kolkata. Journal of Natural Science, Biology and Medicine. 2011 Dec;2(2):211.
❖ Moulin DE, Hagen N, Feasby TE, Amireh R, Hahn A. Pain in Guillain-Barré syndrome. Neurology. 1997;48(2):328–
31.
❖ Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome. Annals of
- Neurology. 199;27(S1):21-24.
❖ Pandey CK, Raza M, Tripathi M, Navkar DV, Kumar A, Singh UK. The Comparative evaluation of Gabapentin and
Carbamazepine for Pain Management in Guillain-Barré syndrome patients in the Intensive Care Unit. Anesthesia and Analgesia. 2005 Jul;101(1):220-5
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Pregabalin?
❖ Very similar in action to Gabapentin ❖ Has been thought of as the superior pharmacological
agent
❖ But... ❖ Safety and efficacy has not been established in children ❖ Not licensed for use in children <12 years ❖ Cost
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Gabapentin fact file
❖ Derivative of GABA ❖ Absorbed via GIT with 80% bioavailability ❖ Distribution: not bound to plasma proteins, penetrates
CSF
❖ Metabolism: Negligible ❖ Excretion: Renal excretion, t1/2 ❖ Adverse effects: dizziness and somnolence, dry mouth,
- edema, blurred vision (dose dependent/reversible)
❖ MOA:*Inhibition of Ca channels
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Pain rating tools
❖ Fraught with difficulty ❖ Few validated tools ❖ Neuropathic pain ❖ Self report requires an alert and communicative child ❖ Autonomic dysfunction ❖ FLACC; Self report; NCCPC-R